Residential Work Permit Application Form (Page 2 of 2) in pdf

BOROUGH OF EDDYSTONE

RESIDENTIAL WORK PERMIT APPLICATION

(1300 E 12th Street, Eddystone, Pa -19022

Phone: 610-874-1100

Fax: 610-874-1605)

SECTION III Continued: PROJECT TYPE & DESCRIPTION **

ALL WORK MUST CONFORM TO UCC **

PROPERTY CURRENTLY LISTED AS: 1- FAMILY [ ] 2- FAMILY [ ] GROUND [ ]

FOR

PERMIT

APPROVAL

DWELLING DESCRIPTION:

DETACHED (Single) [ ] SEMI DETACHED (Twin) [ ]

Residential Rental properties must have

approved Residential Rental Operating

TOWNHOUSE (Row)[ ] T. HOUSE, END OF ROW [ ]

License (RROL) and Tenant Notification

Forms on file with the Borough.

IS PROJECT (JOB) ADDING OR REMOVING A DWELLING UNIT? YES [ ] NO [ ]

PROPOSED PROJECT (JOB): [ ] ADDITION OR REPLACMENT OF DECK, PATIO, PORCH, SUN ROOM, OR DORMER

[ ] REPLACEMENT, WINDOWS, DOORS, ROOF/SIDING, KITCHEN, BATH, HVAC

[ ] CONVERSION OF ROOM TYPE

[ ] ADDITIONS - LEVEL / ROOM / EXTENTION

[ ] ABOVE OR IN GROUND POOL

[ ] GARAGE / CARPORT / SHED / ACESSORY

[ ] DRIVEWAY / RETAINING WALL [ ] FENCING OR SCREENING

[ ] OTHER_______________________________________________________________________

DESCRIPTION OF PROPOSED PROJECT: _______________________________________________________________________

____________________________________________________________________________________________________________

WILL THE PROJECT ADD BUILDING HEIGHT? [ ] YES [ ] NO ** IF YES, NEW BUILDING HEIGHT (FT) ___________

WILL THE PROJECT (JOB) ADD BUILDING SQUARE FOOTAGE? [ ] YES [ ] NO ** IF YES, COMPLETE BELOW

EXISTING BLD. AREA (Sq Ft) ________ EXISTING LOT SIZE (Sq Ft) ________ EXISTING BLD. COVERAGE (%) ________

PROPOSED NEW BUILDING AREA (Sq Ft) _______________ WIDTH (Ft) _______________ LENGTH (Ft) _______________

EXISTING AND NEW TOTAL AREA (Sq Ft) _______________ PROPOSED FINAL BLD. COVERAGE (%) _______________

SECTION IV :

PROJECT COST ($) & APPLICANT SIGNATURE

Contract price or estimated cost is subject to verification by the Building Official, with the assistance of the Borough Engineer. If the contract price or

estimated cost is unrealistic, then the Building Official will make the estimate of the cost which shall be final.

LABOR AND MATERIAL PRICE OF CONTRACT, OR ESTIMATED PROJECT COST ($): _______________________

(Applicant will be notified by the Eddystone Borough official as to the permit fee amount due.)

I certify that the Code Official or the Code Official’s authorized representative shall have the authority to enter areas covered by a permit issue for

this application at any reasonable hour to enforce the provisions of the code(s) applicable to such permit. I hereby certify that the information

submitted herewith is true and correct. I understand that false statements are made subject to penalties. I certify that I am the owner of record for the

property listed, or that I am authorized by the owner of record to submit this application on the owner’s behalf.

___________________________

________________________

___________

Signature of Applicant

Print / Type Name

Date

SUBMIT ALL PERMIT APPLICATIONS AND ATTACHMENTS TO EDDYSTONE BOROUGH HALL.

SECTION V :

DECISION ****

BUILDING CODE OFFICIAL USE ONLY

****

PERMIT COMPLIES WITH ZONING: [ ] YES [ ] NO RESIDENTIAL ZONING DISTRCT (circle one): R1 R2 R3 NB GB

APPOVAL: PERMIT FEE ($) _________________ PERMIT NUMBER (#) _______________ TAX FOLIO#: 18-______________

SUBDIVISION____________________ LOT_______________ BLOCK________________LOT SIZE_____________

DENIED (Explain):___________________________________________________________________________________________

CODE ENFORCEMENT OFFICER SIGNATURE: __________________________________________DATE__________________

Residential Work Permit Application Form Page 2

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